Current Hematologic Malignancy Reports最新文献

Purpose of review: Chronic myelomonocytic leukemia (CMML) is a myelodysplastic/myeloproliferative neoplasm that is characterized by sustained monocytic proliferation, bone marrow dysplasia, and progression to acute myeloid leukemia (AML). Somatic mutations are observed in most patients, with mutations in epigenetic regulatory genes being frequent and often impacting survival outcomes. Deeper understanding of the biological impacts of these mutations has resulted in rationally derived precision therapeutics. Here, we discuss two classes of epigenetic regulator genes and describe the prevalence and impact of somatic mutations in these genes on CMML outcomes.

Recent findings: The increased use and availability of sequencing techniques in the clinical setting has demonstrated the prevalence of mutations in epigenetic regulator genes in CMML. This has provided additional cases to study the impact of these mutations on survival outcomes, leading to the incorporation of some of these mutations in contemporary molecular CMML prognostic models (ASXL1, TET2). Furthermore, advances in understanding epigenetic dysregulation in CMML have led to the development of emerging targeted therapies for select patients. Studying the prevalence of these mutations and their biological implications in CMML may offer an opportunity to identify genotypes likely to respond to treatment or to develop targeted mutation-specific therapies.

Purpose of the review: To summarize evidence and provide an overview of the microenvironment and myeloid-immune cell interactions within the chronic myelomonocytic leukemia (CMML) microenvironment that drive mutation-agnostic pathways of disease progression.

Recent findings: Recent work has demonstrated the importance of myeloid-immune cell interactions in CMML and related myeloid neoplasms. In particular, we focus on the bone marrow microenvironment of CMML, highlighting the role of clonal dendritic cell aggregates and their interaction with other myeloid cells such as monocytes and their precursors, and adaptive immune cells. Several drugs are currently under investigation that target the inflammasome, specific immune cell populations, and immune checkpoint inhibitors with limited success as monotherapy. Immune microenvironment plays a critical role in CMML disease biology and can be targeted for therapeutic benefit. Future research should focus on identifying pathways that are indispensable for progression.

Purpose of review: Chronic myelomonocytic leukemia (CMML) is a rare hematologic malignancy at the intersection of myelodysplastic (MDS) and myeloproliferative neoplasms, predominantly affecting older adults. Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative option, yet its application is limited by the advanced age and comorbidities of most patients. Recent classification updates and refined prognostic tools, particularly molecularly integrated models like CPSS-Mol have enhanced patient stratification and informed transplant timing. The aim of this review is to highlight the evolving landscape of CMML management, with a focus on the role of allo-HCT.

Recent findings: Novel studies patients demonstrated that individualized transplant timing significantly improved life expectancy. Optimizing transplant outcomes hinges on several factors:managing pretransplant splenomegaly, choosing appropriate debulking strategies, selecting optimal donors, and tailoring conditioning regimens. New data favor treosulfan-based and thiotepa-busulfan regimens for their favorable toxicity and relapse profiles. Post-transplant, strategies like post-transplant cyclophosphamide (PTCy) for GVHD prophylaxis and emerging approaches to minimal residual disease (MRD) monitoring offer additional refinements in patient management. While no MRD studies are CMML-specific, extrapolation from MDS supports its role in relapse prediction. Innovative therapies, including hypomethylating agent combinations, venetoclax, targeted inhibitors, and immunotherapies are under active investigation, with potential to improve pre- and post-transplant outcomes. Advancements in molecular classification, dynamic prognostic tools, and therapeutic strategies are reshaping the CMML treatment paradigm. Personalized approaches that integrate genetic risk, patient fitness, and disease characteristics are enabling more effective transplant strategies, with the ultimate goal of extending survival and improving quality of life in this complex and historically difficult-to-treat malignancy.

Purpose of review: This report summarizes key insights from the 8th Annual International Symposium on Myeloproliferative Neoplasms (MPN Asia 2025). The symposium brought together global experts to discuss advancements in MPN biology, diagnostics, and therapeutics, with a focus on emerging molecular understanding, novel treatment strategies and real-world data.

Recent findings: Molecular profiling has become essential in MPN risk stratification and therapeutic decision-making. High-risk mutations (e.g., ASXL1, TP53) and inflammatory pathways (e.g., IL-17, NF-κB) were shown to correlate with disease progression and transformation. Interferon-based therapy is increasingly used in younger, low-risk, or treatment-naïve patients, and is also being investigated in myelofibrosis and essential thrombocythemia. Ropeginterferon alfa-2b, a novel interferon-based therapy, demonstrated durable clinical efficacy in polycythemia vera. Its high initial-dose and accelerated titration (HIDAT) regimen led to fast achievement of complete hematologic response, rapid reductions in JAK2V617F allele burden, and high complete molecular response rate. Combination regimens involving ruxolitinib and agents such as pelabresib, selinexor, and interferon showed potential for enhanced efficacy. Population-based studies from Asia contributed regional epidemiological and treatment data, reinforcing the role of real-world evidence. Modern prognostic models such as MIPSS70+ v2.0 and GIPSS were discussed for more precise risk prediction. Preliminary findings also suggest ropeginterferon alfa-2b may be a safe option during pregnancy. MPN Asia 2025 highlighted the growing role of molecular diagnostics and targeted therapeutics in the management of MPNs. Ropeginterferon alfa-2b has emerged as a therapeutic potential across the MPN spectrum. Its early use and personalized strategies are increasingly recognized. Real-world data and regional insights are shaping a more nuanced, globally informed approach to MPN care.

Purpose of review: Chronic myelomonocytic leukemia (CMML), a rare myelodysplastic/myeloproliferative neoplasm (MDS/MPN) overlap syndrome, poses diagnostic and therapeutic challenges due to its heterogeneity and rarity. This review highlights updates to CMML diagnostic criteria, examines risk stratification models and their clinical implications, and outlines both established and emerging therapies for this rare and likely underrecognized hematologic malignancy.

Recent findings: Updated diagnostic criteria from 2022 reduce the monocyte threshold to 0.5 × 10⁹/L for CMML diagnosis, which will reclassify many cases previously diagnosed as MDS. Risk stratification models continue to be refined allowing for improved prediction and may help select appropriate patients for allogeneic stem cell transplantation, the only curative therapeutic modality in CMML. Although trials in CMML were long relegated to subpopulation of MDS studies, there has recently been a flourishing of novel therapies being tested specifically in CMML. These include lenzilumab (anti-GM-CSF) and IO-202 (anti-LILRB4), which have demonstrated promising early efficacy signals but require further study. Established treatments, which include hypomethylating agents and hydroxyurea as well as the JAK1/2 inhibitor ruxolitinib, provide limited survival benefits in CMML, underscoring the urgent need for novel therapeutic development. Coordinated dedicated research efforts have started to evaluate new agents in CMML. Along with further diagnostic and prognostic refinement, these advances are welcomed for this rare and heterogenous disease.

Purpose of review: In this review, we highlight conventional agents and novel emerging therapeutic strategies to treat anemia in MF.

Recent findings: Anemia is a common and challenging feature of myelofibrosis (MF). The pathobiology of anemia is multifactorial, including progressive bone marrow fibrosis, decreased erythropoiesis due to high hepcidin levels leading to iron sequestration in the reticuloendothelial system, hypersplenism, erythropoiesis inhibition by myelosuppressive JAK inhibitors (ruxolitinib, fedratinib), and others. MF-associated anemia has a negative impact on survival. Conventional agents to manage anemia include erythropoiesis-stimulating agents, danazol, corticosteroids, and immunomodulatory agents, but responses are infrequent and lack durability. Notable advancements have emerged in developing novel treatments for anemia in MF, including the regulatory approval of momelotinib (ACVR1/JAK1/2 inhibitor) in 2023 and development of novel promising agents targeting hemojuvelin and activins. Momelotinib and pacritinib (ACVR1/JAK2 inhibitor) are the preferred JAK inhibitors for patients with cytopenias (anemia, thrombocytopenia). Luspatercept and elritercept are activin receptor ligand traps, promoting erythroid maturation and late-stage erythropoiesis. Currently, luspatercept is being evaluated in a phase 3 trial (INDEPENDENCE™) for anemia in MF patients who are on a JAK2 inhibitor and require transfusions, and in a phase 2 trial (ODYSSEY) in combination with momelotinib in MF patients who are transfusion dependent, whether or not on a JAK inhibitor. Interim results of the RESTORE trial demonstrated that elritercept significantly decreased transfusions in MF patients. DISC-0974 is a first-in-class anti-hemojuvelin (positive hepcidin regulator) monoclonal antibody that decreased hepcidin expression, increased serum iron, and enhanced erythropoiesis in anemic patients with MF in a phase 1b/2 study. Burgeoning studies of novel anemia-targeted agents and combinations are significantly improving the quality of life and outcomes of patients with MF. The recent approval of momelotinib to treat MF with anemia and the emerging novel anemia-directed strategies in early and advanced clinical development have ushered in a new era in the treatment of MF-related anemia.

Purpose of the review: Myelodysplastic syndromes (MDS) are myeloid neoplasms characterized by high molecular and genomic heterogeneity. Accordingly, efforts in risk assessment and therapeutic intervention mostly target unique profiles that individualize specific MDS subtypes. In this review, we explored the contributions of population based studies accounting for MDS as a group.

Recent findings: Large population based studies have been critical to define important details of our current knowledge of the disease. We summarized the most important population research contributions in MDS, focusing on its epidemiology, population risk factors, and relevant clinical associations. We discuss how these population data can provide vital insights to inform prevention measures, testing strategies, and treatment decisions. Population studies play an important role in guiding clinical and research efforts in MDS. Despite its complex molecular and genomic landscape, population data is integral to define the burden of disease, identify risk factors and clinical associations, and can help elucidate pathogenic mechanisms.

Purpose of review: Cutaneous T cell lymphomas (CTCLs) are comprised of a heterogenous group of non-Hodgkin lymphomas that can be difficult to treat and are often refractory to standard therapies. Mycosis fungoides (MF) and Sezary syndrome (SS) are the most common subtypes, accounting for the majority of CTCLs. There is no standard of care, and no treatments are curative. In this review, we summarize the promising, recently reported data describing novel systemic agents for the management of MF/SS.

Recent findings: Clinical trials are currently exploring a number of agents, including novel chemotherapies, antibodies and antibody drug conjugates (ADCs), immunotherapy, and cellular therapies. These promising novel agents may expand the treatment landscape for MF/SS.

Purpose of review: More than a decade following the discovery of Calreticulin (CALR) mutations as drivers of myeloproliferative neoplasms (MPN), advances in the understanding of CALR-mutant MPN continue to emerge. Here, we summarize recent advances in mehanistic understanding and in targeted therapies for CALR-mutant MPN.

Recent findings: Structural insights revealed that the mutant CALR-MPL complex is a tetramer and the mutant CALR C-terminus is exposed on the cell surface. Targeting mutant CALR utilizing antibodies is the leading therapeutic approach, while mutant CALR-directed vaccines are also in early clinical trials. Additionally, chimeric antigen receptor (CAR) T-cells directed against mutant CALR are under evaluation in preclinical models. Approaches addressing the cellular effects of mutant CALR beyond MPL-JAK-STAT activation, such as targeting the unfolded protein response, proteasome, and N-glycosylation pathways, have been tested in preclinical models. In CALR-mutant MPN, the path from discovery to mechanistic understanding to direct therapeutic targeting has advanced rapidly. The longer-term goal remains clonally-selective therapies that modify the disease course in patients.

Purpose of review: Multiple myeloma is a chronic malignancy and with evolving treatment options, understanding the economic burden and cost-effectiveness of therapies is crucial for clinicians and researchers.

Recent findings: In this, we review the recent approval of Bispecific antibodies and CAR-T for myeloma and their cost implications, including direct and indirect costs. We compare this to current regimens and provide cost comparisons in this review. We conclude that the use of more effective therapies such as CAR-T in earlier lines of therapies may be more cost-effective depending on the country and model used. Further studies are essential to better understand the cost-effectiveness of bispecific antibodies including head-to-head comparisons to CAR-T therapy.